冈上肌腱撕裂患者在肩痛指导下采用经胸肌下入路行肱二头肌肌腱固定或切断术的临床疗效。
Clinical Outcomes After Biceps Tenodesis or Tenotomy Using Subpectoral Pain to Guide Management in Patients With Rotator Cuff Tears.
机构信息
University of Connecticut Health Center, Farmington, Connecticut, U.S.A.
University of Connecticut Health Center, Farmington, Connecticut, U.S.A..
出版信息
Arthroscopy. 2019 Jul;35(7):1992-2000. doi: 10.1016/j.arthro.2019.02.017. Epub 2019 Jun 10.
PURPOSE
To assess whether preoperative subpectoral tenderness in patients with rotator cuff tears was associated with arthroscopic findings of tendinopathy of the long head of the biceps, as well as whether they had resolution of their subpectoral tenderness postoperatively after tenodesis or tenotomy.
METHODS
Patients presenting between 2011 and 2016 undergoing arthroscopic rotator cuff repair were evaluated preoperatively with the subpectoral biceps test (SBT). This test is performed with the arm adducted and internally rotated to allow palpation of the biceps as it courses under the pectoralis major tendon. Preoperative SBT findings determined operative management with either tenodesis or tenotomy during rotator cuff repair. Patients were followed up postoperatively to assess resolution of subpectoral tenderness with a repeated SBT. Preoperative and postoperative Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons, and Constant-Murley scores were recorded in all patients.
RESULTS
A total of 128 patients were enrolled in the study, with a mean age of 58 years (range, 33-82 years). Patients with a positive preoperative SBT (n = 68) had significantly lower SANE and Constant-Murley scores preoperatively (P < .01) than patients with a negative SBT (n = 60). All patients with a positive preoperative SBT underwent either tenodesis or tenotomy, with 94% of patients (n = 64) having resolution of subpectoral pain and tenderness at final follow-up. Intraoperatively, 93% of patients with a positive SBT showed gross pathologic changes in the tendon (fraying, erythema, tears, or subluxation) compared with only 65% of patients with negative preoperative examination findings (P < .01). American Shoulder and Elbow Surgeons, Constant-Murley, and SANE scores were significantly increased postoperatively in all patients (P = .02).
CONCLUSIONS
In this group of patients with rotator cuff tears surgically treated with concomitant biceps tenodesis or tenotomy, 94% had resolution of their subpectoral tenderness. A positive SBT was associated with gross pathologic changes of the biceps in 93% of patients.
LEVEL OF EVIDENCE
Level III, prospective comparative study.
目的
评估肩袖撕裂患者术前胸肌下压痛与肱二头肌长头腱病的关节镜表现是否相关，以及在接受肌腱固定术或肌腱切断术后，他们的胸肌下压痛是否会得到缓解。
方法
2011 年至 2016 年间，对接受关节镜肩袖修复术的患者进行术前评估，采用胸肌下二头肌试验（SBT）。该试验在手臂内收和内旋时进行，以便在胸大肌腱下触诊二头肌。根据术前 SBT 检查结果，决定在肩袖修复术中进行肌腱固定术或肌腱切断术。对所有患者进行术后随访，以重复 SBT 评估胸肌下压痛的缓解情况。所有患者均记录术前和术后的单一评估数字评分（SANE）、美国肩肘外科医生协会评分和 Constant-Murley 评分。
结果
共纳入 128 例患者，平均年龄 58 岁（范围，33-82 岁）。术前 SBT 阳性（n=68）的患者 SANE 和 Constant-Murley 评分明显低于术前 SBT 阴性（n=60）的患者（P<.01）。所有术前 SBT 阳性的患者均行肌腱固定术或肌腱切断术，94%（n=64）的患者在最终随访时胸肌下疼痛和压痛得到缓解。术中，93%的 SBT 阳性患者的肌腱有明显的大体病理改变（磨损、红斑、撕裂或半脱位），而术前检查结果阴性的患者仅为 65%（P<.01）。所有患者的美国肩肘外科医生协会评分、Constant-Murley 评分和 SANE 评分在术后均显著增加（P=0.02）。
结论
在接受肱二头肌肌腱固定术或肌腱切断术联合治疗的肩袖撕裂患者中，94%的患者胸肌下压痛得到缓解。93%的 SBT 阳性患者的肱二头肌有明显的大体病理改变。
证据等级
III 级，前瞻性比较研究。
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